摘要
目的 观察光相干断层扫描(OCT)参数对年龄相关性黄斑变性(AMD)患者抗血管内皮生长因子(VEGF)治疗疗效的评估价值.方法 选取AMD患者104 例,所有患者均接受抗VEGF治疗及OCT检查,比较治疗前后最佳矫正视力(BCVA)、黄斑中心凹厚度(FMT)、黄斑中心凹神经上皮层厚度(NRT)及脉络膜新生血管(CNV)面积,根据治疗效果将患者分为有效组与无效组,采用多因素logistic分析AMD患者抗VEGF治疗疗效的影响因素,并采用受试者工作特征(ROC)曲线分析其对疗效的评估价值.结果 治疗后AMD患者BCVA、FMT、NRT及CNV面积均较治疗前降低(t分别=12.54、11.68、26.80、8.79,P均＜0.05),且Pearson相关性分析显示,BCVA与AMD患者FMT、NRT及CNV面积均呈正相关(r分别=0.56、0.48、0.51,P均＜0.05).104 例AMD患者中,77 例患者经抗VEGF治疗后归为有效组,27 例为无效组.有效组患者FMT、NRT及CNV面积均低于无效组(t分别=4.33、3.16、4.37,P均＜0.05).多因素logistic回归分析显示,FMT、NRT及CNV面积均是AMD患者抗VEGF治疗疗效的独立影响因素(OR分别=1.95、1.57、1.83,P均＜0.05).ROC特征曲线显示,FMT、NRT及CNV面积评估AMD患者抗VEGF治疗疗效的最佳截断值分别为319.26 μm、220.18 μm、5.12 mm2,且三项指标联合评估的AUC为0.86,高于单一指标(Z分别=2.13、3.31、2.47,P均＜0.05).结论 OCT能监测AMD患者抗VEGF治疗前后FMT、NRT及CNV面积变化情况,且FMT、NRT联合CNV面积对AMD患者抗VEGF治疗疗效的评估价值较高,可作为AMD患者疗效监测的有效手段.
Abstract
Objective To observe the evaluation value of optical coherence tomography(OCT)parameters on the effi-cacy of anti-vascular endothelial growth factor(VEGF)therapy in age-related macular degeneration(AMD)patients.Methods A total of 104 AMD patients were selected,all of whom received anti-VEGF therapy and OCT examination.The best corrected visual acuity(BCVA),foveal macular thickness(FMT),neural retina thickness(NRT)and choroi-dal neovascularization(CNV)area were compared before and after treatment.The patients were divided into effective group and ineffective group according to treatment effect.Multivariate logistic analysis was used to analyze the factors af-fecting the efficacy of anti-VEGF therapy in AMD patients,and receiver operating characteristics(ROC)curve was used to analyze the evaluation value of the efficacy.Results After treatment,BCVA,FMT,NRT and CNV areas in AMD pa-tients were all decreased compared with those before treatment(t=12.54,11.68,26.80,8.79,P＜0.05),and Pearson cor-relation analysis showed that BCVA was positively correlated with FMT,NRT and CNV area in AMD patients(r=0.56,0.48,0.51,P＜0.05).Among 104 AMD patients,77 were classified as effective group after anti-VEGF treatment,and 27 were ineffective group.The FMT,NRT and CNV area in effective group were lower than those in ineffective group(t=4.33,3.16,4.37,P＜0.05).Multivariate logistic regression analysis showed that FMT,NRT and CNV area were indepen-dent factors influencing the efficacy of anti-VEGF therapy in AMD patients(OR=1.95,1.57,1.83,P＜0.05).ROC char-acteristic curve showed that the best cutoff values of FMT,NRT and CNV area to evaluate the efficacy of anti-VEGF therapy in AMD patients were 319.26 μm,220.18 μm and 5.12 mm2,respectively,and the AUC of the combined evaluation of the three indexes was 0.86,which was higher than that of single index(Z=2.13,3.31,2.47,P＜0.05).Conclusion OCT can monitor the changes of FMT,NRT and CNV area before and after anti-VEGF treatment in AMD patients,and FMT,NRT combined with CNV area has a high evaluation value on the efficacy of anti-VEGF treatment in AMD patients,and can be used as an effective means to monitor the efficacy of AMD patients.
维普
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